Bob Simpson and Salla Sariola (University of
Durham)
Stabilising Science: Reflections on Detachment and Collaboration in
the Conduct of Trials in Developing World Contexts
Clinical trials are one of the basic means whereby the efficacy and safety of drugs, treatments and appliances is established. In order to accomplish this, the logic of experimentation and standardisation is held to be paramount – trials yield facts, (measurements, data, statistics) the interpretation of which must capable of overcoming challenge and contradiction. The material presented in this paper is drawn from a project which has set out to look at what happens when these procedures emerge as part of international biomedical research collaborations operating in developing country contexts and specifically in Sri Lanka. In such collaborations, differences of language, culture and biomedical tradition must be overcome and incorporated into the emerging assemblage. In other words, the linearity of the trial – that is, as an objective tool for the production of verifiable inferences that has ostensibly been carried out just like all other trials – is not simply about replication but in practice but also relies on acts of creativity on the part of those conducting the trials. Convergence on universal standards requires strategies that are at once novel, contingent and unexpected but also largely invisible in the official discourse surrounding trials and their results. In ethnographic terms, the work that goes on to achieve the effect of stabilisation is of particular interest.
First, interest in this work suggests a preoccupation which it is in many ways the aim of this workshop to challenge, and that is the desire that social scientists have to thicken relationality, extend networks and amplify the ‘social’ at every turn. In this vein, the research we have undertaken has as its central object the ubiquitous notion of collaboration. Using collaboration as a means to hold things steady in the complex flow of people, technologies and resources that characterise an increasingly ‘globalised’ science brings into view a variety of social practices. For example, it draws attention to transnational assemblages characterised by knowledge and resources in the global north yet research subjects in the south. It also brings into view bioethics as a recent and specific instance of the way in which science seeks to take account of society in the context of biomedical research. Furthermore, collaboration, as practice, conveys a sense of the quality of relations that should be fostered in order to discover and innovate effectively. In the terms laid out by Gibbons et al and Nowotny, each of these represents good mode 2 science in action.
Our concern here, however, is not limited to the notion of the social implicit in this idea of mode 2 science. An ethnography of international clinical trials gives a glimpse of scientific conduct that has not just taken account of the social in a generic sense but has done so in very specific ways. The social is itself shot through with cultural idioms, deportments, strategies and meanings and within these are to be found particular patternings of relationality between persons and between persons and objects. Within these practices are also found distinctive ways of cutting or trimming those patterns. In other words, those involved with clinical trials are not simply subordinate and substitutable within the logic of the experiment, but are actors who bring a range of knowledge, understanding, mis-understanding and motivation to the accomplishment of the trial. An ethnography of clinical trials suggests that rather than mode 2 science , what we are seeing might be better characterised as mode 2n science, that is, one of a multiplicity of ways in which the appearance of stable, replicable and objective science might be achieved.
After an excursus into what a mode 2n science might look like, we come into a closer alignment with the theme of the workshop: what it is to create objectivity within the distinctive relationalities that mark collaborative science in practice. The introduction of clinical trials into Sri Lankan hospitals brings with it challenges to existing practices, roles and relationships for a range of medical personnel [doctors, laboratory assistants, researchers, clinical trials assistants, patients etc]. In this paper we discuss several examples of the discipline that comes with the trial including the use of blinding, randomisation and placebo. All of these introduce different configurations of attachment and detachment into relationships that previously existed between patients, doctors and other hospital personnel.
